Background

We investigated the prevalence of obesity-related multimorbidity (i.e., co-occurrence of ≥2 obesity-related chronic diseases) and the risk of developing one disease in the presence of multimorbidity and degree of obesity in the U.S.

Methods

National Health and Nutrition Examination Survey data, 2007-2016, were used. We targeted hypertension (H), diabetes (D), coronary heart disease (C), and stroke (S). Age-standardized disease prevalence was calculated. We estimated the risk of developing each disease conditional on age, race/ethnicity, gender, measured body mass index, pre-existing disease(s), duration of pre-existing disease(s), and duration squared. We adjusted for the complex sampling design.

Results

Our sample (n=14,243) represents 110,003,550 individuals in the U.S. population age 40-79 years. Age-standardized prevalence for obesity-related multimorbidity was 12.3%: 10.3%, 1.8%, 0.2% for two, three, and four diseases, respectively. H was most often the first diagnosed disease for populations with obesity-related multimorbidity. Compared with no pre-existing disease, (1) C+S increased the risk of H (multivariable-adjusted hazard ratio, aHR, 6.0, 95% confidence interval, CI, 4.1-8.6); (2) C+H+S increased the risk of D (aHR 8.2, 95% CI 3.6-19.0); (3) H+S (aHR 27.6, 95% CI 10.9-70.2), D+H+S (aHR 20.3, 95% CI 7.9-52.2), or D+S (aHR 13.1, 95% CI 4.2-40.8) increased the risk of C; and (4) C+D+H (aHR 32.6, 95% CI 12.2-87.1) or C+H (aHR 25.4, 95% CI 12.1-53.6) increased the risk of S.

Conclusions

Obesity-related multimorbidity was prevalent in the U.S. population with a high correlation between the development of these diseases. Prevention and intervention strategies are essential to reduce the burden of multimorbidity.